Strategic Planning & Timelines

The ACA contains several provisions that may alter the scope and practice of public health. As a result, governmental health departments must evolve in order to accommodate the new health landscape and changing demands on the system. In the wake of these health systems changes, public health faces new opportunities and challenges. This recently-released Research Insights brief examines the role of public health following ACA implementation by looking at three innovative approaches to governmental public health – in Massachusetts, San Diego, and Vermont.

Whether they have health insurance through an employer or buy it on their own, Americans are paying more out-of-pocket for health care now than they did in the past decade. A Commonwealth Fund survey fielded in the fall of 2014 asked consumers about these costs. More than one in five 19-to-64-year old adults who were insured all year spent 5 percent or more of their income on out-of-pocket costs, not including premiums, and 13 percent spent 10 percent or more. Adults with low incomes had the highest rates of steep out-of-pocket costs. Two of five adults with private insurance who had high deductibles relative to their income said they had delayed needed care because of the deductible.
 

The ACA presented new challenges for states to develop models for health system and payment reform, implement health insurance marketplaces, and expand Medicaid. This created a need for states to fully understand and utilize data sources in order to effectively implement, monitor, and evaluate health care reform. To assist states in this effort, SHADAC, with support from the Office of the Assistant Secretary for Planning and Evaluation, developed a series of white papers that are focused on innovative uses of data resources and analytic approaches that states can apply to monitor and evaluate health care reform efforts. The series provides an overview of data sources available to state policymakers, such as state-level administrative data, health insurer filings, marketplace enrollment data, and survey data. The series also highlights key analytic questions that states could use the data sources to address.
 

The ACA’s employer mandate requires large firms to pay penalties unless they offer affordable health insurance coverage to full-time employees, raising concerns that employers might lay off workers or reduce hours. This brief estimates the number of workers potentially at risk of losing their jobs or having hours reduced. Fewer than 10 percent, less than 0.03 percent of the U.S. labor force, might see reductions in employment or hours in the short run. Over time, employment patterns might change, leading to fewer firm sizes and work schedules near the thresholds, potentially affecting up to 0.5 percent of the workforce.
 

Under the 2010 Affordable Care Act, millions of Americans gained health coverage in 2014. Coverage is key to accessing affordable, high-quality care, but consumers who struggle to understand how health insurance works and how to estimate out-of-pocket costs are at risk of going without needed care even if they are covered. This brief outlines what health insurance aspects pose the greatest problems for consumers, which groups need more assistance to enroll and use benefits, and what topics and skills consumer-counseling efforts should focus on.